157 Hickory Drive Lot 5 Section 3D"IE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Art le 13C)
OWNER OR CONTRACTOR 1-,II)Alq :linQ DATE (nom /%"%PERMIT
LOCATION N? 590
S.R. NO.
SUBDIVISION NAME �rn��/iriinur� /iQr S LOT NO.
NO. BEDROOMS 3
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
YES
❑
NO
❑
YES
❑
NO
❑
YES
❑
NO
❑
YES
❑
NO
❑
gal.
NITRIFICATION FIELD
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
IMPROVEMENTS PERMIT BY \
(8/16/73)
LOT AREA
sq. ft.
❑ Public
SECTION OR BLOCK NO.
House Trailer 800 Gal. 400 Sq: Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
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*975k'in -to 9,0 g;-J1VF;9x00- /M%CI
INSTALLED BY )6n .'L , 5 T- Cm -4b. --A
OF COMPLETION By %,ae , f\ aMAa Date 6 - -16 " %s
*Construction must Amply with all other applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
t' (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal Systgm - G.S. Chapter 130 -Art Is 13C)
OWNER OR CONTRACTOR LJQun/U U/A/I �� DATE PERMIT
LOCATION 4,01-5 Al;oj' S..l...l N?
SUBDIVISION NAME S4 IA tmatlej r1+Le LOT NO.
NO. BEDROOMS '
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NO. BATHROOMS
YES
❑
NO
❑
YES
❑
NO
❑
YES
❑
NO
❑
YES
❑
NO
❑
gal.
NITRIFICATION FIELD
DEPTH OF STONE IN LINESs'
WATER SUPPLY: Individual
IMPROVEMENTS PERMIT BY C
sq. ft.
❑ Public 21
SECTION OR BLOCK NO.
House. Trailer 800 Gal.
Two Bedroom House 800 Gal.
Three Bedroom House 900 Gal.
Four Bedroom House 1000 Gal.
INSTALLED BY
561
400 Sq. Ft..
600 Sq. Ft.
900 Sq. Ft.
1200 Sq. Ft.
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction -must comply with all other applicable State and local regulations
LOT AREA
4-1
DAVIE COUNTY HEALTH DEPARTMENT
tic Tink) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter. 130-Arti„Fle 13C)
OWNER OR CONTRACTOR L DATE PERMIT
LOCATION d p�' St �u lIi b� �C N? 561
S.R. NO.
SUBDIVISION NAME j��,}�„ � /l 5 LOT NO. SECTION OR BLOCK NO.
HOUSE IM MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS_ NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH'OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION BY Date
(8/16/73) *Construction must comply with all other applicable State and'local•regulations
LOT AREA
DAVIE COUNTY HEALTH DEPARTMENT
r (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR L N l 1 ) — --._-. __ ........DATE �� - �. -7.1,— PERMIT
LOCATION
SUBDIVISION NAME Sem4,,,e &rl Ac gyms, LOT NO.
NO. BEDROOMS 0-21
NO.
BATHROOMS
_
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO.
DISHWASHER
YES
❑
NO
❑
AUTO.
WASH. MACHINE
YES
❑
NO
❑
SITE
SUITABLE
YES
❑
NO
❑
SIZE
OF TANK
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
IMPROVEMENTS PERMIT BY C
❑ Public X
SECTION OR BLOCK NO.
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 80Q -a1:
Three Bedroom House �O Gales' 900 Sq_Ft—"
Four Bedroom House 000Gal. 1200 Sq. Ft.
I
I
INSTALLED BY
CERTIFICATE OF CUMPLET'IUN By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
E
DAVIE COUNTY HEALTH DEPARTMENT
•..r 4 ��. (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR^ "' 'r"M
r. ��L c i � °»•^- ,.DATE PERMIT
LOCATION (, �R� i'�•E.e<, r'.•� .N° 533
S.R. NO.
SUBDIVISION NAME p,�, ,y),, -„y^ wr� �.a� �� q; LOT NO. SECTION OR BLOCK NO.
nuubt LJ MUrilLL` KUMtS u nuJtighbb I
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal. .
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:.
WATER SUPPLY: Individual ❑ Public tR
IMPROVEMENTS PERMIT BY
(8/16/73)
LOT AREA
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House8�Gal. '' 600 Sq,,.Ft.
Three Bedroom House Li'900 Gal ii!�900^Sq. Ft.
Four Bedroom House
1a0Ga1'. 1200 Sq. Ft.
INSTALLED BY
OF UUMPLETIM - . _. - .
By Date
*Construction must comply with all other applicable State and focal regulations
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL AND ECONOMIC RESOURCES
RALEIGH
APPLICATION FOR PERMIT TO DISCHARGE WASTEWATER FROM
.. PRETREATMENT FACILITIES.TO WAST'EIRATER TREATMENT FACILITIES OF ANOTHER
CUTLETS AND POINT SOURCES AND TREATMENT WORKS AND DISPOSAL SYSTEMS
l '
DISCHARGING TO THE SURFACE.WATERS OF.THE STATE
Filed By: 04). X� s G
Davie - Yadk�N -Dirk};,-4- Nea/44 De.p+.
,r dJCebb)
C, z70 _Z 9
1-1a,it AppP,icati.onb To:
N. C. DephAtmen.t o6 Natwwt and Economic Rebounceb
Divizion o5 Env.0 nmentaZ Management
WateA Quatity Section
P. U. Box 27687
Ra.2eigh, North. Canotuuc 27611
��.p ication No.
Section I GENERAL INFOR14ATION
1. Name of Applicant
Date Reviewed
2. Mailing address of applicant
Street RT 7 or Box No. --Q66-,q
Post Office State Al. C. _Zip zip -a70 a sy
3, Location of Treatment Works and discharge point
County Zk U) f e- City of Town
Street No, or other location/description
Jow7L/w00a/ /'YGteS 51 b�i'
4. Check type of application moi/% Original Revision
�. Does..=this application inclu a proposed construction
.3—. Jed YobM atwe 11WCr U.JcMe CONS kGTionl - .
,= yes =. no
If yes' -complete 6, 7, and 8. If no go to No. 9. _-
6. DescIriptio/n. of_ Proposed Works/ Ga70 .Sca F!
�-c11
bid ( See cc-r_H ed o p�L o!-
_'1-ev?s a /MJ�i-oyemenlTS
7, Construction Schedule
Plans and Specifications submitted on or before
(date)
j Begin Construction on or before
(allow 30 days for plan review) (date)
Complete Construction on or before
date )
'_uitifiued
:age Two
f
Begin Operation on or before as
$. Name and address of Design Engineer
SooN A -S TVSS"�'e
1 a Y
(date
9, Name and title of person responsible for the works
10. Is discharge to f�'Surface waters or L= Treatment.Plant of
Another Owner?
11. If discharge is to surface waters name of receiving stream
and river basin rya a�KiN
12. If discharge is-to'Plant.of -Another Name --of Owner
and location of plant
Ps
Section II DISCHARGE DESCRIPTION3S p GSI �D^y
1. Design average daily discharge (daily. -average -for --30 days) MGD._
2. Design maximum daily discharge-(one,day-maximum -in 30 days) _-
MGD
3, Design peak discharge rate (peak hoar flow in MGD) MGD
continued
Page Three
4. Date by which design average will be reached
5. Waste Characteristics
Parameter
Influent
Effluent
% reduction
ph
xxxxxxxxxxxx
Temperature (winter) (FO)
OF
OF
xxxxxxxxxxxx
Temperature (summer) (FO)
OF
OF
xxxxxxxxxxxx
BOD 5 day 20° C
m /l
mg/l
Total Solids
m /l
mg/1
Total Susbended Solids
m /l
mg/l
TKN N)
m /l
mg/l
Nitrate -Nitrite (N)
mg/l
mg/1
Phosphorus (Total)
mg/l
mg/l
Turbidity
XXX=XXJTU
F Coliform Bacteria
xxxxxxxxxxx
100.ml
I
Application is hereby made for a permit to discharge those waste-
waters described herein. I certify that I have reviewed and am
familiar -with iriformation.:contained--in thisapplication,,--and-that
to the best of my knowledge and belief such information is true,
complete and accurate.
�o%ei-� L. "// , T
Printed name of person signing
Title
S nature of Appli t
Date
Juno 21. 1975
Mr Robert L 0a11 J
Route 7s.,Boz 266-A.',
Mocksvvillss R.. , C. : 27028:.:
SUBJECT: Coaditlmal Approval of.Wastewater.Tr[stment.
Facilities to servo Routs $� Lot'�,.3� BouCir, :.
Food Acres, Davis County, Nortli Carolina,.
Dear Mr. ;walls, ,
In,'accordence.with your. application:.for a permit to discharge treated
wastewater to -the surface waterecif North Carolinas and after staff, review
and determination that the discharge v111'100t Violatewater quality stan-
dards, you are hereby authorised to construct wastewater treatment facili-
ties consisting of a 90.sip=e foot sub -surface sand filter and eventually
the disinfection facilities which together will treat -the domestic waste
from the proposed septic tank and sufficient nitrification lied acceptable '.
to the Davie County Environmental Health Department. -The discharge will
be made into Leonard: Creek,, a; tributary. to . tkc( Dutchman creekwhich is in
diti
the Yadkin -Pea Des River.Basin. Thio authorization Is coaoml upas:
subsequent issuance of a discharge permit by, the North Carolina Environ-
mental - Management, Commiasioa.
Yoai.;aiVlication for permit will be processed as provided for.ft,
reguletions adopted by the Environmental Management Commission, and a per-
mit containing such restrictions and conditions as deemed necessary will
be issued.' In the interim, the construction and operation of the facili-
ties authorized herein are subject to periodic review and modification'as'
necessary to Insure continuous protection of surface waters of the State.
If this office can be of further easistance,,please feel free to ca12
Robert A. Carters'Regioca]. Engineers North Piedmont Field Office, 3528
Vest Mill Roads'Winston-Salems'North Carolinas 27103, telephone (919) 765-
6300.
Sincerely,
Original Signed B)Z
LEWIS R. MARTIN
Lewis R. Martin
cc: Mr. L. P. Benton, Jr.
Mr. W. C. Mills
Mr. R. Van Tilburg
MMyy W: E. Long. Jr.
✓bowie County Environmental Health Department
North Piedmont Field Office